7.4: Contexts- School and Learning Diversity in Middle Childhood
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Learning Objectives
By the end of this section, you will be able to:
- Discuss the functions of school ing for child development
- Describe formal and informal school environments that support cognitive development
- Discuss diversity in learning needs, diagnoses, and resources
Tamika is starting in a new school. Her last school was very academic, and the teachers provided a highly structured curriculum, supporting students as they learned. Her new school encourages children to be much more creative and unrestricted in their learning, and the classroom is full of centers that allow active, hands-on experimentation for this purpose. Tamika’s foster mother is excited about this new way of learning, but worries that it may be harder for Tamika to grasp all the important concepts she will need for the future.
Education is a key part of the daily lives of most children during middle childhood. The cognitive advancements you studied earlier in this chapter allow children to learn more efficiently and to think in more sophisticated ways. Throughout this time, children are becoming much more proficient in mathematics, reading, and writing. The educational experiences they have now are the foundation for their attitudes about formal learning and will affect their success in school up to and even beyond adolescence.
Schooling as a Context for Middle Childhood
In most countries, children spend a significant part of their daily lives in school, where they are taught the cognitive skills that will help them to be successful as adults. According to Robinson and Robinson (2022), schooling serves four important purposes for children: 1) to engage with their world, 2) to understand their culture and respect diversity, 3) to become economically independent and 4) to become productive citizens.
In many places, it is easy to take children’s ability to go to school for granted and to assume that this opportunity has always been available. However, in most countries, attending school has only been possible for fewer than 200 years. In the United States, public education began during the colonial period in New England, where Puritans required children to learn reading, writing, and religion (Crooks, 2023). However, in other colonies, only a very small percentage of children attended school, and it was usually only boys and those from the wealthiest families. By the end of the 1800s, free compulsory education became widespread across the country, which meant that all children could receive a formal education, regardless of the social status of their family. Formal education now served to unify the country as well as to encourage immigrants to assimilate. Changes in job opportunities and city structures in the late 1800s to early 1900s, due to industrialization, also required individuals to have higher rates of literacy.
Although free mandatory education is available throughout the United States, this option is not universal around the globe. Across the world, approximately 16 percent of children do not attend school (UNESCO, 2023). In many parts of the world, girls have less access to education due to gender inequality, poverty, early marriage and/or gender-based violence (UNESCO, 2023). Although only 2 percent of countries explicitly restrict the rights of girls to attend school, only 33 percent of countries protect their rights to an education.
As well as providing critical academic achievements, schools offer a context for children to develop social competencies, as well as skills that will allow them to fully participate in society as they achieve adult independence. Formal schooling also provides necessary care for children during the day so that parents can work. In addition, because teachers are mandatory reporters and are often more familiar with typical development than many parents, formal schooling provides a potential pathway for the early detection of developmental delays, child maltreatment, or other health risks that may negatively impact child development and academic success.
School Environments and Influences
During middle childhood, learning can take place through formal education provided by teachers and other specially trained professionals. Important learning also happens through informal education , which can take place anywhere, including at home. Informal settings may be particularly useful for combatting disparities in education. For example, participation in STEM (science, technology, engineering and mathematics) programs in informal settings, such as museums, science centers, zoos, and aquariums, are associated with less stereotypical beliefs about gender and STEM engagement, likely because children are exposed to educators and professionals that do not fit the typical gender stereotypes (McGuire et al., 2020).
Theoretical Approaches to Education
Theories of education can influence the way teachers approach education in their classrooms. Two such theories are behaviorism and constructivism . Behaviorism, as an educational philosophy, focuses on the idea that student behavior can be influenced by the classroom environment. A teacher provides a stimulus to which the student responds, and the teacher positively reinforces the desired response or punishes an undesired response.
Ultimately, the teacher is using behavioral techniques to achieve results, like effective learning. Positive reinforcement is a consequence for behavior that increases the likelihood the behavior will be repeated. Some examples include praising a child for providing a correct response, giving extra recess time for completed homework, and hanging exemplary work in the classroom. Similarly, teachers may use punishment s for undesirable behaviors that are designed to decrease the likelihood that a behavior will be repeated. Some examples are: sending a misbehaving student to the principal’s office, giving a student detention for failing to complete homework, or calling parents to report misbehavior in the classroom.
Given the many benefits of positive reinforcement for changing behaviors, best practices for schools focus on positive reinforcement for managing student behavior (Wilkins et al., 2023). However, relying solely on rewards and punishments to control student behavior may lead to learning just for the rewards (extrinsic motivation), rather than learning for the sake of learning (intrinsic motivation) (Ryan & Deci, 2020). Since intrinsic motivation is associated with better academic achievement (Burton et al., 2006), educators should balance the use of behaviorist techniques with opportunities for students to learn through engaging assignments designed to address relevant real-world problems, to allow students to choose what they learn, or to demonstrate their learning through portfolios (Mathewson, 2019).
Jean Piaget proposed the idea of constructivism , which suggests that students play an active role in acquiring knowledge by constructing it through experience, rather than just passively receiving information. Lev Vygotsky’s sociocultural theory of cognitive development offered another view, arguing that cognitive development happens through the social interactions that occur when adults or more capable peers guide children’s learning in the zone of proximal development (Miller, 2011). The zone of proximal development consists of the knowledge or skills the student doesn’t yet have but can achieve with the help of someone else. The teaching method that helps students learn in this model is referred to as scaffolding , which is when students receive support from more capable individuals to acquire new knowledge or develop new skills (Figure 7.15).
In a classroom setting, constructivism becomes a teaching strategy in which teachers guide children to think for themselves and encourage collaboration for problem-solving. The teacher becomes a facilitator who guides learning, rather than an individual who provides direct instruction.
Formal Schooling
In the United States, formal schooling typically begins around age five or six when a child enters kindergarten, although the age at which schooling is required varies by state. Some researchers have argued that seven is the most appropriate age for beginning formal schooling (Whitebread & Bingham, 2013). In fact, that is when many children start formal schooling in other countries, including Afghanistan, Indonesia, and Niger. In contrast, other countries, including Trinidad and Tobago, New Zealand, Pakistan, and Sri Lanka, have children start their primary education when they are as young as five (The World Bank, 2023). Seven is also the age at which Piaget proposed that children enter the concrete operational stage and become capable of using logic and solving concrete problems. Regardless of the age at which formal schooling begins, middle childhood is synonymous with school-age and is a period of critical learning.
Formal schooling provides education in a systematic and organized manner. It focuses on achieving specific learning goals with the aid of a trained educator and a formal learning environment. The methods and classroom settings can vary from highly structured to more student-driven but still teacher-guided (Figure 7.16).
Classrooms that are characterized by direct instruction from a teacher are teacher-centered classroom s (Heal, 2023). Teachers are the focus and have full control over what happens in the classroom. Students take a more passive role and learn through drills, quizzing, and presentations. Although this method ensures that students will be exposed to all relevant topics, it may be less engaging for some and does not encourage children to direct their own learning. It also does not encourage collaboration or critical thinking.
Student-centered classrooms, on the other hand, are characterized by equal interactions between students and teachers (Heal, 2023). This teaching method leans heavily on ideas by Piaget and Vygotsky; it encourages children to actively construct their own learning by engaging in problem-solving activities and collaborative learning with peers (Khadidja, 2020). Montessori and Waldorf models of education are built around the idea of student-centered education (Attfield, 2022; Mavric, 2020). The teacher functions as a guide who encourages exploration and challenges children to think more deeply, reflecting on the process rather than on specific facts. Disadvantages of this method include the possibility of noisy or chaotic classrooms, difficulties with managing group work, and the risk that students may miss some important facts because instruction is not directly delivered to all.
In addition to the more formalized, official curriculum outlined in the lesson plans, the hidden curriculum is a set of unspoken, unofficial, and often unintended rules and values that students learn while attending school. The hidden curriculum, first described by Philip Jackson (1968), is seen in the way the school is organized, the way students are assigned to classes, and the schedules and physical characteristics of the school. For example, students who attend a school with a strict dress code receive an implicit message about the importance of conformity over individuality and self-expression (Friedrich & Shanks, 2023).
The hidden curriculum can influence students in both positive and negative ways (Halstead & Xiao, 2023). It often reinforces the values and expectations of society by teaching social skills and providing students with skills and knowledge they need to succeed in the real world, like effective time management and collaboration. For example, children may improve their patience and collaboration skills through taking turns during classroom activities. However, the hidden curriculum may also reinforce stereotypes or exert other negative influences on children. For example, schools that have metal detectors may reinforce the idea that school is a dangerous place, and schools that have classrooms filled with signs about rules without interesting art or educational images may reinforce the idea that learning is never fun.
In 2001, the No Child Left Behind Act mandated that schools regularly administer achievement tests to measure knowledge and skills children have learned (Redding & Nguyen, 2020). No Child Left Behind was controversial for several reasons, and in 2015 it was replaced with the Every Student Succeeds Act; the new law is viewed as more flexible, but maintains significant requirements for testing and score reporting. The scores are published so parents, educators, and government officials can examine performance within schools as well as within demographics, such as social class and racial and ethnic groups. The goal of the tests is to increase student learning and academic achievement by holding educators accountable for student performance, and scores are often used to make decisions about how federal and/or state funding is distributed to schools. As a result of their serious consequences, these are often referred to as high-stakes test s (Eggen & Stobart, 2016).
High-stakes testing is very controversial (Bradbury et al., 2021). Supporters argue that these tests provide important information about student knowledge and skill acquisition, and that they encourage teachers to use more effective teaching strategies. However, critics claim that this type of testing is unfair to teachers and students in schools with inequitable resources and, as a result, there are significant socioeconomic and ethnic disparities in performance on these tests. Specifically, high-stakes tests harm more students of color and English-language learners (Solorzano, 2019). In addition, because the test results are so influential, schools are often criticized for “teaching to the test” and for putting too much focus on scores. The curriculum may then be less engaging for students and not allow for student-centered learning. Students and teachers often may feel punished for test scores, particularly when pressure to improve scores can be at the expense of recess and extracurricular classes such as music. Finally, teachers have less agency over what and how they teach because of the pressure to prepare students for these high-stakes tests and, as a result, report lower levels of motivation, which negatively impacts student performance and increases student stress (Acosta et al., 2020; Heissel et al., 2021). Schools may be able to reduce these negative impacts by providing mental health support and maintaining a positive learning environment that maintains extracurriculars such as the arts (Heissel et al., 2021; Ishiguro et al., 2023).
Informal Schooling
Informal schooling takes place outside the traditional classroom and includes extracurricular activities and any other learning that may take place in daily life. For example, parents regularly teach their children skills such as tying their shoes, completing chores around the house, and helping at mealtime. Peers are also a source of learning when children gain knowledge and discover new interests through interactions with friends and classmates.
Up until the 1970s, most children in the United States attended formal schooling environments. Since then, there has been an increasing number of students who have been homeschooled (Gaither, 2017). Homeschooling can take many different forms, but is generally any form of education that takes place outside of a traditional school environment (Carlson, 2020). Homeschools may be led by one adult or a group of them, may be structured and regulated or completely lacking in requirements, and may be done in peer groups or one-on-one. In the United States, there was a significant increase in homeschooling due to the COVID-19 pandemic. In 2019, approximately 3 to 4 percent of children were homeschooled and, by the 2021–2022 school year, about 6 percent of school-aged children were homeschooled (Ray, 2024). Homeschooling is also growing in many other countries, including Australia, Canada, France, Kenya, Russia, the Republic of Korea, and Thailand (Ray, 2024). However, homeschooling is much less common in other countries, such as Italy, Israel, Chile, and Turkey (Neuman, 2019), and is illegal in others, including Germany, Cuba, Brazil, and China (Barbosa, 2016; Sheng, 2018).
Families choose homeschooling for a variety of reasons. These include: the ability to customize the curriculum and learning environment for individual children, including those with unique learning needs; the ability to protect minority children from racism and lowered expectations that schools may have for children of color; or the ability to focus on a particular set of values and beliefs (Fields-Smith, 2020). In fact, the most common reasons parents reported for homeschooling were concern over the school environment, being unhappy with previous academic instruction received at school, or wanting to provide specific religious or moral instruction to their children (McQuiggan et al., 2017). While a goal of homeschooling may be to support a child’s unique learning needs, the lack of regulation and the lack of access to special education services may mean some children with disabilities receive less support in certain homeschool environments (Carlson, 2020).
There are both advantages and disadvantages to homeschooling. Homeschoolers may have less opportunity to engage in organized group activities, which may limit their ability to develop teamwork strategies and practice social skills (Sakarski, 2024). However, if children are involved in extracurricular activities and homeschooling cooperatives that give them opportunities to socialize with other children, they can effectively develop these social skills (Feraco et al., 2022). Children who were homeschooled often do as well as or better than children attending formal school on standardized academic achievement tests (Ray, 2017; 2024). Homeschooled adolescents describe advantages, like more choices in learning, greater confidence and imagination, and strong family support (Figure 7.17), as well as disadvantages, including lower test-taking and social skills, lower motivation, and fewer friendships (Neuman, 2020). Overall, the advantages and disadvantages of homeschooling can be quite difficult to determine due to the lack of regulation across various states and countries, the wide variability in quality, and the difficulty of researching homeschooled children who receive the least structured and regulated forms of homeschooling.
Link to Learning
The homeschooling movement has grown significantly because of the COVID-19 pandemic. As a result, it is important to consider how homeschooling impacts the education of children. Read this article about homeschooling to learn more.
Regardless of whether they are homeschooled or attend a traditional, formal school, many children spend time participating in extracurricular activities . These structured activities are voluntary, and are supervised by adults (Mahoney et al., 2005). They include organized sports, arts programs for music or dance, gaming clubs, 4-H, and other community programs such as scouting, public library programs, or after-school programs. In 2020, 44 percent of boys and 35 percent of girls were on a sports team, while 37 percent of girls and 27 percent of boys took music, dance, or other types of lessons (Mayol-Garcia, 2022). Although participation in extracurricular activities has increased over the past two decades, significant disparities in participation by income status and neighborhood type exist. For example, children in poverty are less likely to participate in extracurriculars due to limited resources in parental time for transportation and financial limitations in paying for equipment or fees (Mayol-Garcia, 2022). Children living in more metropolitan areas are also more likely to engage in extracurricular sports (Johnson et al., 2023).
Participation in extracurricular activities has several positive benefits for children, including better mental health, higher academic performance, more positive social relationships, increased self-esteem, improved social skills, and fewer risky behaviors (Aumètre & Poulin, 2018; Oberle et al., 2019; Vandell et al., 2015). However, concerns have been raised about the potential negative effects on mental health, sleep, and social life of being involved in too many extracurricular activities (Caetano et al., 2023). As a result, caregivers should encourage their child(ren) to choose a couple of activities at a time and to make sure that they also have some unscheduled time.
Life Hacks: The Overscheduled Child?
In a world where there are so many options for extracurricular activities for children, is there such a thing as too much? Many children—whose parents have the financial means and schedule flexibility—can participate in multiple activities including organized sports teams, dance, gymnastics, martial arts, scouting, or music lessons, all of which may have social, physical, or cognitive benefits (O’ktamovna, 2024). However, research has suggested that too many extracurricular activities may not be beneficial and may even be harmful for children. For example, some researchers have coined the term “Hurried child syndrome,” which refers to children who have overfilled schedules and who are pushed to be academically successful and to succeed in numerous extracurricular activities (Kashyap & Sharma, 2022). These children have more physical health problems, higher levels of stress, reduced creativity, and social isolation (Halemani, 2023).
In response, there is a growing movement to provide children with more downtime to relax. Unstructured time is associated with improved life skills and allows for quality family time (Walsh, 2017). Since there are benefits to participation in extracurricular activities as well as for unstructured leisure time, adults should strive to balance the opportunities to develop skills and passions through participation in extracurricular activities with some unstructured free time.
Influences on Academic Achievement
Regardless of school context (formal or informal), students are influenced by a variety of people and issues in their educational experience. For example, the Pygmalion effect is the impact of teacher expectations on student academic achievement (Rosenthal & Jacobson, 1968). These expectancies may come from experiences with individual students but are also based on teacher bias. For example, studies have shown that when teachers believe boys are better at math or girls are better at reading, children perform to these expectations, even when their actual abilities are not consistent with the teacher’s beliefs (Plante et al., 2013; Retelsdorf et al., 2015). Such bias may explain, in part, why there are gender gap s in reading and math during middle childhood (Friedrich et al., 2015).
A recent report shows that girls outperform boys in reading (Global Education Monitoring Report Team, 2022). For example, in Saudi Arabia, 77 percent of girls but only 51 percent of boys reach a minimum proficiency in reading. Although it is smaller, the gender gap for reading also favors girls in other countries such as the Dominican Republic, Lithuania, Morocco, Thailand, and Norway. On the other hand, boys perform better than girls in mathematics during middle childhood, though this gender gap disappears by adolescence (Global Education Monitoring Report Team, 2022). In other research, around half of countries studied had gender equity in math and science achievement (Mullis et al., 2020). Gender gaps in science and math are less likely to be present in more gender-equal societies (Global Educational Monitoring Report Team, 2022). However, boys continue to be overrepresented in careers requiring both math and science, suggesting that gender stereotypes and biases continue to influence the academic choices of children and extend into STEM careers and other career selections.
Student beliefs and motivations also influence academic achievement. Those with high self-efficacy , which Albert Bandura defined as confidence in their ability to solve a problem or complete a task, and who believe they can be successful, achieve more than students without self-efficacy (Musu-Gillette et al., 2015). Students who believe they can be successful in school tend to be more motivated in school. For example, students with high self-efficacy set higher goals for themselves to achieve, work harder, are more persistent in their pursuit of those goals and outperform peers with lower self-efficacy (Honicke et al., 2023). Similarly, both intrinsic and extrinsic motivations can promote better learning and academic achievement (Burton et al., 2006; Matthewson, 2019). For example, students are likely to learn more effectively when they enjoy what they are learning and may expect a reward, such as a good grade due to their efforts.
According to Carol Dweck’s mindset theory , students with a growth mindset have more positive developmental outcomes than those with a fixed mindset, the belief that their abilities are fixed and can’t be changed (Dweck et al., 2019). If ten-year-old Mario approaches a challenging assignment by saying, “This looks hard, but I think I can do it if I work hard,” he is demonstrating a growth mindset . Having a growth mindset is associated with less anxiety and depression (Schleider & Weisz, 2016) as well as with improved grades and increased enrollment in more advanced courses in math (Yeager et al., 2019). However, the growth mindset is most effective if reinforced by teachers who endorse the learner’s beliefs (Yeager et al., 2022). For example, if a student insists they are not good at math, a teacher may reinforce a fixed mindset by saying, “Maybe math isn’t your strength, but you do other things well.” However, the teacher may encourage a growth mindset by stating, “Let’s keep working on this problem. I’ve seen you make great progress this year when you keep trying on a problem!”
Life Hacks: Develop a Growth Mindset
A growth mindset is the belief that our cognitive abilities can be changed, while a fixed mindset is the belief that those abilities are stable. Although the positive impacts of a growth mindset have been supported by research, findings are mixed about whether academic outcomes are higher for children with a growth mindset (Yeager & Dweck, 2020). Other research has shown that interventions designed to change students’ mindsets do not influence student achievement (Macnamara & Burgoyne, 2023). One possible reason is that schools send mixed messages to children when they promote a growth mindset while at the same time focusing on performance outcomes. In addition, students likely come into the school year with a particular mindset as the result of past experiences with other teachers, their families, and peers.
Another criticism of growth mindset theory is that it underestimates the effects of innate abilities such as intelligence, and that it can make children feel like they are entirely responsible for their outcomes. In turn, that ignores the fact that many factors outside children’s control, such as poverty and systemic racism, have a real impact on academic achievement (Alexander, 2015).
Despite these criticisms, having a growth mindset is more likely to promote positive outcomes than having a fixed mindset. So, what are some strategies that support developing a growth mindset? According to Carol Dweck (2014), who first identified mindset theory, there are several steps that can help:
- Praise wisely. In other words, praise should focus on effort and perseverance over intelligence or talent. For example, “you tried so hard” is preferable to “you must be so smart!”
- Reward wisely. Rewards, such as good grades, should be based on effort and strategy instead of exclusively on correct answers.
- Remember the word “yet.” In other words, if there is a setback or failure, it isn’t permanent, and a lot of learning can occur through mistakes and persistence.
- Change mindsets by being willing to persevere at challenging and difficult tasks.
To learn more about Carol Dweck’s research and tips, review this brief presentation on developing a growth mindset from Dweck.
Diversity in Learning
We can observe a wide range in children’s ability to learn. Most schools are structured for neurotypical learners, so they need to give special consideration to students who are more advanced learners or who have learning disabilities.
Learning Disabilities
A condition that affects learning in a specific academic area such as reading, writing, math, or speech is called a learning disability . They are some of the most common disabilities diagnosed in children (American Psychiatric Association, 2022). To diagnose a learning disability, a child will be given a variety of assessments which may include an IQ test and a test of academic achievement. Learning disabilities are not due to an intellectual impairment or other physical or sensory disability and do not reflect the child’s intelligence (Swanson, 2023). Thus, a child with a learning disability has a significant gap between their overall ability and their achievement in a specific cognitive area.
A common learning disability that results in difficulties in reading is known as dyslexia (Vaughn et al., 2024). Characteristics include poor spelling, and problems reading from left to right, and difficulties associating letters with sounds. Dyslexia is likely due to differences in the areas of the brain responsible for language and reading (Kershner, 2019). Dyslexia occurs in approximately 7 percent of children with rates varying by country (Yang et al., 2022). For example, Nigeria has a rate of 11 percent while Slovakia has a rate of 2 percent. These differences may be due, in part, to differences in writing systems across languages (Siok & Quin, 2022). Relatedly, dysgraphia is a learning disability in writing and often occurs with dyslexia (Chung et al., 2020). Children may have difficulties sounding out words, writing them phonetically, or forming letters with pen or pencil. They may write text that is poorly organized on the page or have trouble with spelling, grammar, and punctuation. These difficulties may persist into adulthood (McCloskey & Rapp, 2017). Approximately 10 to 30 percent of children have some difficulties with their writing. However, the actual prevalence of dysgraphia is dependent on how it is defined.
A child may be diagnosed with dyscalculia , a learning disability in math (Butterworth, 2005). Children may have difficulties learning basic math rules, using math symbols, understanding math problems, or understanding how numbers work. Rates of dyscalculia are similar to the rates of dyslexia (Monei & Pedro, 2017), although they may vary by country and geographical region (Keong et al., 2016). For example, rates of dyscalculia are higher in rural areas than in urban areas (Keong et al., 2016). Causes of dyscalculia include biological factors, differences in brain functioning, and specific cognitive deficits (Skagerlund & Traff, 2014). Fortunately, interventions have been shown to be effective in helping children who are having difficulty learning mathematics (Monei & Pedro, 2017).
Attention-Deficit/Hyperactivity Disorder (ADHD)
Neurodevelopmental disorders emerge during childhood as the nervous system develops. These disorders negatively impact a child’s ability to function in one or more settings such as home and school. One of the more common neurodevelopmental disorders is attention-deficit/hyperactivity disorder (ADHD) , which is characterized by inattention, hyperactivity, impulsivity, and deficits in executive functions (Peterson et al., 2024). There are three ways it can present itself based on which symptoms are most problematic (Table 7.5) (Konst et al., 2014). This discussion of ADHD focuses on childhood diagnosis and experiences, but ADHD often persists into adulthood and may also be initially diagnosed in adults.
| ADHD Presentation | Description |
|---|---|
| Predominately inattentive | Child has difficulty following instructions, paying attention to details, and organizing or finishing a task. |
| Predominately hyperactive-impulsive | Child displays excessive fidgeting and talking, difficulty sitting for longer period of times, and restlessness. Has trouble with impulsivity and difficulty waiting their turn or listening to instructions. |
| Combined presentation | Child has symptoms of both predominately inattentive and predominately hyperactive-impulsive forms. |
A child with ADHD may struggle to attend to some tasks, like schoolwork, but may be hyper-attentive to other tasks that they find rewarding or interesting (like rock collecting or playing video games). Other symptoms of inattention include a failure to follow instructions, lack of attention to detail, and easily becoming distracted (Cai et al., 2023). Signs of hyperactivity in children with ADHD include excessive movement, fidgeting, squirming, difficulty remaining seated, and talkativeness (Ayano et al. 2023). They may also be more impulsive than other children. For example, they may shout out the answers to questions in class before they are called on or not consider the safety implications of running to grab a ball that rolled into the street.
Children with ADHD also often have deficits in executive functioning. For example, research has shown that impaired spatial working memory and inhibitory control among children with ADHD (Rastikerdar et al., 2023). Children with ADHD do not have any intellectual impairments when compared to children without ADHD, but they may struggle in school because of their difficulties with executive functioning. For example, they may not give themselves enough time to complete large projects, or they may forget to turn in completed homework. As a result, compared to children who do not have ADHD, children with ADHD may have lower grades in school, higher rates of grade retention and of dropping out of school (Iines et al., 2023).
ADHD occurs in approximately 5 percent of children between three and twelve years of age (Salari et al., 2023), a rate that has increased over the past several decades. It’s likely that actual cases have not been rising, but that teachers, parents, and medical professionals are more aware of and more likely to recognize the symptoms and refer children for a diagnosis. Diagnostic techniques and screening processes have also improved, making it easier to diagnose a child (Abdelnour et al., 2022).
Boys are three times more likely than girls to be diagnosed with ADHD (Reuben & Elgaddal, 2024). Boys with ADHD are also more likely to display externalizing behaviors such as increased running and impulsivity, whereas girls are more likely to show internalizing behaviors such as low-self-esteem and inattentiveness. The externalizing behaviors are more likely to be disruptive at home or at school and may explain, in part, why boys are more likely to be diagnosed (Mowlem et al., 2019). However, if all children in a community are screened, gender differences in the diagnosis of ADHD disappear (Assari, 2021) supporting the idea that higher rates of ADHD are due to more noticeable symptoms.
Globally, rates of ADHD vary from one country to another. For example, research has reported that approximately 8 percent of Turkish children have ADHD (Zorlu et al., 2020) while about 18 percent of children in Tunisia (Mhalla et al., 2018) and one-quarter of children in South Africa have ADHD (de Milander et al., 2020). There are also racial disparities in diagnosis. Rates of ADHD are higher in Black children than in White children; Hispanic children are less likely to receive a diagnosis of ADHD than White children (Shi et al., 2021). The reasons for these disparities are not completely understood, but some research has suggested that cultural values impact the likelihood that parents will seek a diagnostic evaluation for their children (Bradley, 2007) and that systemic racism may impact both the diagnosis and treatment of ADHD (Johnson et al., 2017).
There are several possible causes for ADHD including genetics , preterm birth and maternal use of substances like acetaminophen during pregnancy (Banaschewski et al., 2017; Ji et al., 2020; Kim et al., 2020; Sourander et al., 2019). More than seventy-six potential risk genes have been identified for ADHD (Demontis et al., 2023) and many of these are important for the regulation of the neurotransmitter dopamine. There is also research that has linked structures in the brain to ADHD. Most of these studies have focused on the frontal lobe and the prefrontal cortex, and suggest that the frontal lobe is less developed in individuals with this diagnosis (Hoogman et al., 2019). Since the frontal lobe is responsible for executive functions, attention, impulse control and planning, delays in frontal lobe development explain many of the behaviors seen in children with this disorder. Importantly, despite widely held beliefs, there is no evidence that sugar consumption is related to increased hyperactivity (Kramer, 2023) and, although, food additives have been shown to increase hyperactivity, the overall impact is very small (McCann et al., 2007).
Appropriate treatments, including medication and therapy, can significantly improve outcomes among individuals with ADHD (Arnold et al., 2015). One of the most frequent treatments is medication. In particular, the use of stimulants such as Ritalin, Vyvanse, and Adderall have been shown to increase dopamine activity and to have benefits for academic performance and reduced risk behaviors (Faraone et al., 2021; Storebø et al., 2023). Increasingly, medications for ADHD also involve the use of non-stimulant medications such as Straterra and Wellbutrin (Isaac et al., 2024). Although it may seem unusual to prescribe a stimulant to children with symptoms of hyperactivity, these medications activate the prefrontal cortex and frontal lobe. However, there is quite a bit of controversy about the use of medications to control symptoms. There are problematic side effects, which include disrupted sleep, decreased appetite, and headaches, as well as concerns that the use of stimulant medication can lead to people developing tolerance and/or withdrawal symptoms, leading to the need for progressively increased doses and potential overuse or misuse (Lovett et al., 2024). As a result, many parents may prefer to consider other treatment options. One of the most common treatments is cognitive behavioral therapy (CBT), a type of therapy that helps children change negative thought processes to more positive thought processes. Children with ADHD who have received CBT have better long-term outcomes than children treated with medication (Rajeh et al., 2017). Furthermore, the combination of CBT and medications has the most benefits, likely because the medication has an immediate effect that gives the child the focus to gain the most benefit from CBT (Li & Zhang, 2023).
Educational Services for Exceptional Learners
You may have heard the term exceptional learner , which is currently used to describe a child who has a variety of special needs (Hallahan et al., 2020). Starting in the 1970’s, important federal laws were passed in the United States that have increased the rights of children with disabilities. In 1973, the Rehabilitation Act of 1973, Section 504 (PL 93-112) was passed. This law mandates that any individual with disabilities needs to be accommodated in any program that receives federal funding.
Since 1990, the Americans with Disabilities Act (ADA) has prohibited any kind of discrimination on the basis of a disability. This law extends its protections beyond organizations receiving federal funding to cover employment, and it also requires that accommodations be made in public facilities like restrooms and public transportation. In school settings, this legislation led to accommodations like wheelchair-accessible doorways and restrooms (Figure 7.18).
In the United States, the Individuals with Disabilities Education Act ensures that any child with a disability from birth to age 21 has access to free and appropriate education (United States Department of Education, 2024). The law also included specific provisions such as that education for a child with a disability should take place in the least-restrictive environment , meaning that wherever possible children should be included in general education with peers who do not have disabilities.
This law also requires public schools to provide an individualized educational program (IEP) to any child who receives special education and/or related services. An IEP is a written plan that spells out the specific educational goals and services that have been individualized for a student with a disability. The specific services vary based on the child’s individual needs and might include physical therapy, speech/language therapy, occupational therapy, and counseling.
Link to Learning
Young people with ADHD learn to expect negative comments, even from some teachers. But teachers report they do not get enough training to properly support neurodivergent students. Watch Ebony Thompson make a personal and impassioned plea for more training in personalized learning to learn more.
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